Conservative surgery for renal cell carcinoma--indications, technique and results

At the Department of urology in Hradec Králové between 1989-1993 287 patients with a tumor of the kidney were operated on, in 45 of them (15.6%) conservatively. In this set there are 29 men and 16 women with the mean age 56.5 years. In 29 patients the contralateral kidney was normal (64%), 5 patients underwent nephrectomy for renal cell carcinoma, in 9 patients the opposite kidney was hypofunctionalised (hydronephrosis, cysts). In two patients the conservative approach was used for reasons of another type of malignancy (haematological). In 33 (73.3%) patients enucleation, in 12 patients resection of the lower or upper pole were done. The tumor was classified as T 1 stage in 6 patients, but in 4 patients already as T 3a (in patients with imperative indication). In 35 patients the tumor was moderately differentiated, in two ones with histologically confirmed renal cell carcinomas the tumors were poorly differentiated, in 8 patients there were histologically adenomas, in one angiomyolipoma and in another case scar after PCN (percutaneous nephrolithotomy). Preoperative examination included immunological examination, this was not done in two patients. Good results were obtained in 21 patients (60%), 12 patients were in high risk and 6 of them received immunotherapy. As an early complication one patient had urinary fistula, which resolved after introduction of stent. Relapse of malignancy in the screening period was not noticed.